Changes to the CMS-HCC Model for 2011

As noted in our last post, the updated CMS-HCC Model codes were posted to our website on 9-29-2010.  You can view the file on our Tools Page.  But, what are the changes to the model for 2011?

In short, CMS has:

• Deleted two codes from the model --279.4 and 453.8.  Both of these codes are truncated codes, i.e., not at the highest level of specificity
• Deleted three codes from HCC 80--404.03, 404.93 and 404.13.  Note that these codes all still map to HCC 131
• Added 8 new codes to the model. All of these codes are new ICD-9 codes.  While the codes are effective 10-1-2010, they do not count in the CMS-HCC model until 1-1-2011.

See below for details.

ICD-9-CM Code	ICD9_Description	CMS-HCC Model Category	CMS HCC Model 2011	Action Taken	Comments
40413	Ben Hyp Ht/Kid W Hf/Kid	80	No	Deleted from this HCC	Although this diagnosis remains in the model under HCC 131, it no longer maps to HCC 80.
2794	Autoimmune Disease Nec	45	No	Deleted from the model	This diagnosis code was removed from the model. It is not at the highest level of specificity, and more specific codes in this section remain in the model.
4538	Venous Thrombosis Nec	105	No	Deleted from the model	This diagnosis code was removed from the model. It is not at the highest level of specificity, and more specific codes in this section remain in the model.
40493	Hyp Hrt/Kid Nos W Hf/Kid	80	No	Deleted from this HCC	Although this diagnosis remains in the model under HCC 131, it no longer maps to HCC 80.
40403	Mal Hyp Hrt/Kid W Hf/Kid	80	No	Deleted from this HCC	Although this diagnosis remains in the model under HCC 131, it no longer maps to HCC 80.
44770	Aortic ectasia, site NOS	105	Yes	Added	This is a new diagnosis code for 2011. The code is effective 10-1-2010, but not included in the model until 1-1-2011.
56032	Fecal impaction	31	Yes	Added	This is a new diagnosis code for 2011. The code is effective 10-1-2010, but not included in the model until 1-1-2011.
23773	Schwannomatosis	10	Yes	Added	This is a new diagnosis code for 2011. The code is effective 10-1-2010, but not included in the model until 1-1-2011.
23779	Neurofibromatosis NEC	10	Yes	Added	This is a new diagnosis code for 2011. The code is effective 10-1-2010, but not included in the model until 1-1-2011.
78033	Post traumatic seizures	74	Yes	Added	This is a new diagnosis code for 2011. The code is effective 10-1-2010, but not included in the model until 1-1-2011.
44773	Thoracoabd aortc ectasia	105	Yes	Added	This is a new diagnosis code for 2011. The code is effective 10-1-2010, but not included in the model until 1-1-2011.
44772	Abdominal aortic ectasia	105	Yes	Added	This is a new diagnosis code for 2011. The code is effective 10-1-2010, but not included in the model until 1-1-2011.
44771	Thoracic aortic ectasia	105	Yes	Added	This is a new diagnosis code for 2011. The code is effective 10-1-2010, but not included in the model until 1-1-2011.

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